Dermal fillers in the U.S.: HA, CaHA, PLLA and how volume typically lasts

A friend asked me a deceptively simple question over coffee: “Which filler lasts the longest?” I paused, because I’ve learned that the honest answer is layered. Longevity depends on the material, where it’s placed, how much is used, how our faces move, and even how our bodies metabolize things. That curiosity sent me down a rabbit hole—sorting out the differences between hyaluronic acid (HA), calcium hydroxylapatite (CaHA), and poly-L-lactic acid (PLLA), and what “typical” truly looks like for volume over time. This post is me laying out what clicked for me, in a diary-style way, with the practical notes I would share with someone sitting across the table, latte in hand.

The three filler families in plain English

Here’s how I make sense of the big three used in the U.S., without any hype:

• Hyaluronic acid (HA) — a water-loving gel our bodies recognize. It plumps by binding water where it’s placed. It comes in many versions (softer or firmer, depending on cross-linking). A meaningful advantage: HA can be reduced with hyaluronidase if a touch-up goes sideways or if you simply change your mind later.
• Calcium hydroxylapatite (CaHA) — tiny mineral-like particles in a gel carrier. It behaves more like a structural filler and may cue some collagen formation around those particles. It’s often used for deeper folds or contouring (think cheeks or jawline) rather than super-fine lines.
• Poly-L-lactic acid (PLLA) — more of a “biostimulator.” Instead of giving instant heft, it nudges your skin to build its own collagen over weeks to months. Usually done as a series of sessions, with gentle massage after injections as part of the routine plan your clinician may recommend.

The big picture: HA gives mostly immediate volume, CaHA gives structure and some collagen response, and PLLA builds gradually. All three are used by licensed clinicians in the U.S. and are regulated as medical devices here.

How long the volume typically lasts in real life

When people ask “how long,” what they want is a number. What I’ve learned is a set of ranges, because no one can guarantee a precise timeline for your face and your habits. That said, here’s a conservative, evidence-informed snapshot of typical persistence of visible volume for the three families—assuming appropriate product choice, placement, and technique:

• HA: often around 6–12 months for many facial areas. Some firmer HA gels in less mobile zones can persist longer in some people, but I keep my expectations in the 1-year ballpark and treat anything beyond that as a nice bonus rather than a promise.
• CaHA: commonly about 12–18 months. Many clinics set follow-ups around the one-year mark. How sculpted or animated the area is (cheek contour vs. smile lines) changes the practical “feel” of how long it seems to last.
• PLLA: after a series, improvement tends to build gradually and can remain ~1–2 years or more for some, with maintenance sessions as advised. Because collagen turnover is personal, this one is especially individualized.

Movement matters. High-motion zones (lips, perioral) sit at the shorter end of the range for any material. Areas with less motion (temples, lateral cheek) often feel longer-lived. So does the total amount placed and how it’s layered over time. The goal I’ve adopted is “steady refresh” rather than a one-and-done expectation.

Why the same syringe lasts differently from person to person

I used to think longevity was just about the brand on the box. It turns out that’s only part of the story. These are the quiet factors I now pay attention to:

• Product traits: HA comes in different cohesivities and particle sizes; CaHA particle concentration varies; PLLA requires reconstitution and timing between sessions. Those choices influence how a filler resists motion and water shifts.
• Placement depth and technique: Deep support vs. very superficial smoothing are not the same job. Depth, angle, and how product is fanned, threaded, or micro-aliquoted all change the visible arc over months.
• Area movement and expressions: Smiling, chewing, kissing, and speaking are wonderful—and they also mean fillers in the lips and perioral area live busy lives. That translates into shorter persistence compared to, say, a lateral cheek contour.
• You, uniquely: metabolism, sleep, smoking status, sun exposure, and baseline skin quality all matter. None of these are deal-breakers; they’re the “why” behind tailored maintenance plans.

My simple framework for choosing between HA, CaHA, and PLLA

Having tried to make sense of all the opinions online, I now start with this step-by-step sanity check and stick to it:

• Step 1 — Name the job. Are we smoothing fine lines, restoring cheek structure, or treating generalized thinning? Instant volume and shape change often points me to HA or CaHA; “I’m okay waiting for gradual, natural-feeling improvement” points me toward PLLA conversations.
• Step 2 — Think reversibility. If I want maximum peace of mind for a first-time lip or tear-trough treatment, I like knowing HA has a known reversal pathway with hyaluronidase. CaHA and PLLA do not have a quick “eraser,” so I approach those with even more care on sizing and placement.
• Step 3 — Map the maintenance. I ask myself, “What schedule would I actually keep?” If I’m happy to do subtle top-offs every 9–12 months, HA or CaHA feels easy. If I’d rather front-load a series and then coast, PLLA may suit my patience level.
• Step 4 — Match budget to plan. It’s not just the per-syringe cost; it’s number of sessions and longevity. Thinking in terms of the yearly plan helps me and my wallet stay friends.

What I personally track after each appointment

Keeping good notes has saved me from guesswork months later. I keep a “filler passport” (a simple shared document in my phone) with:

• Product + lot number (ask your clinician to share it), total volume, and where it was placed.
• Before/after photos under similar lighting, taken at day 0, week 2, month 3, and month 6 (or 12 for CaHA/PLLA plans).
• Any reactions I experienced (bruise, swelling, tenderness), and how long they lasted.
• Touch-up window we tentatively aimed for, so I’m not scrambling when life gets busy.

Gentle rules I live by to help results feel natural

• Small, then build. If I’m unsure, I start conservative and add later. Faces read better with micro-adjustments than with big jumps.
• Respect anatomy. Providers trained in facial anatomy, complication management, and device specifics are non-negotiable for me. In the U.S., fillers are medical devices; I avoid non-medical settings and anything sold directly to the public.
• Expect the ebb and flow. Swelling can briefly make results look “extra.” I don’t judge the outcome until 1–2 weeks for HA/CaHA and several weeks for PLLA. For PLLA, I follow massage instructions provided by the clinician.
• Sun-smart + skin health. Consistent sunscreen and barrier-friendly skincare won’t make a filler last forever, but they protect the overall canvas and help my results look better for longer.

Red and amber flags I don’t ignore

Most side effects are mild and short-lived: tenderness, a small bruise, a little swelling. Still, I keep a short list of signals that tell me to pause and seek help without delay:

• Sudden severe pain, blanching (pale) skin, or mottling near the injection area.
• Vision changes, eye pain, or a sudden headache after treatment.
• Worsening redness, warmth, or fever suggestive of infection.
• Firm nodules or delayed swelling that doesn’t settle or that appears weeks to months later.

If any of that happened to me, I’d contact my treating clinician immediately; for vision changes or severe symptoms, I’d seek emergency care. With HA, there is a known option (hyaluronidase) that trained clinicians use when appropriate; for CaHA and PLLA, management is different, which is another reason I insist on experienced injectors who know the playbook.

Putting numbers in context area by area

Because so many of us want a sense of what to expect, here’s the way I think about typical ranges by commonly treated areas, keeping in mind that individual plans vary and none of this is a promise:

• Lips (usually HA): higher motion means many people schedule refreshers around the 6–9 month zone, accepting that subtle softening often starts sooner.
• Nasolabial folds & marionette lines (HA or CaHA): around 9–15 months is a reasonable planning window for many; CaHA can be closer to the upper end when placed appropriately.
• Cheeks / midface (HA, CaHA, or PLLA): often 12–18 months with HA/CaHA; PLLA builds over a series and can maintain improvements beyond a year, with maintenance per plan.
• Temples / jawline (CaHA or PLLA, sometimes HA): typically leans toward the longer side of the ranges because motion is lower and volumes sometimes higher.
• Under-eye area (usually HA): conservative dosing and precise technique matter more than the calendar; some people choose longer intervals here to keep things subtle.

I treat these as planning anchors, not expiration dates. My calendar reminder reads “Check in with photos + how it feels,” not “this must be redone now.”

Safety notes I keep on my refrigerator door

• Only in medical settings. I avoid parties, salons, or needle-free “pens.” In the U.S., approved fillers are prescription medical devices meant for trained clinicians using syringes or cannulas.
• Know what’s being used and where. I ask for the patient information handout and keep it with my notes.
• Share my medical story. Blood thinners, prior reactions, autoimmune conditions, vaccination or dental plans—my injector needs the full picture to time things safely.
• Plan downtime realistically. Swelling and bruising are normal. I don’t stack big events in the first week after facial injections, and I follow aftercare exactly as given.

What I’m keeping and what I’m letting go

Two mindset shifts have made this feel healthier and less stressful for me:

• Longevity is a range, not a pledge. I stop looking for the mythical “brand that lasts twice as long for everyone.” Matching the job to the material (and the injector’s strengths) is the quiet superpower.
• Maintenance is normal. I don’t interpret a touch-up at 9–12 months as failure; that’s the design. Skin ages, faces move, and preferences evolve. The goal is harmony, not permanence.

If you’re comparing HA, CaHA, and PLLA, I hope this helps you ask clearer questions and set kinder expectations. A great plan feels like a conversation that covers your anatomy, your timeline, your appetite for reversibility, and what “natural” means to you—then chooses the family of fillers that best fits you.

FAQ

1) Which filler family tends to last the longest?
Answer: In many people, PLLA maintenance can extend results beyond a year after a series, while CaHA often sits around the one-year-plus range and HA frequently around 6–12 months. Exact timing varies by area, technique, and individual factors.

2) Can fillers be reversed if I don’t like the look?
Answer: HA has a known pathway for reduction with hyaluronidase performed by trained clinicians. CaHA and PLLA do not have a quick “dissolve” option, so planning and conservative dosing are even more important with those.

3) Do fillers stretch out the skin over time?
Answer: Skin adapts to many changes, but there’s no guarantee of a specific long-term effect either way. In practice, conservative dosing, spacing sessions appropriately, and keeping skin healthy (sun protection, gentle skincare) help results look natural over time.

4) Is it safer to combine fillers with other treatments like Botox the same day?
Answer: Many people receive neuromodulators and fillers in coordinated plans, but safety depends on the details of your treatment and your health history. Your clinician will time and stage treatments based on best practices and your goals.

5) What should I ask during a consult?
Answer: Ask about the specific product family and why it fits your goals, where and how it will be placed, expected range for longevity in that area, the follow-up plan, and how complications are managed. Request patient information for the product and keep it for reference.

Sources & References

• FDA — FDA-Approved Dermal Fillers
• FDA — Dermal Filler Do’s and Don’ts
• American Academy of Dermatology — Fillers FAQs
• Mayo Clinic — Facial Fillers for Wrinkles
• Cleveland Clinic — Dermal Fillers Overview

This blog is a personal journal and for general information only. It is not a substitute for professional medical advice, diagnosis, or treatment, and it does not create a doctor–patient relationship. Always seek the advice of a licensed clinician for questions about your health. If you may be experiencing an emergency, call your local emergency number immediately (e.g., 911 [US], 119).